Tomography Of Paranasal Sinuses Research Articles

A clinicopathological study of patients with sino nasal polyposis in tertiary care centre

<p class="abstract"><strong>Background:</strong> Masses in sino nasal cavity presents with wide range of complaints like nasal obstruction, nasal discharge, epistaxis, headache, swelling in and around the nose, through clinical examination, rigid nasal endoscopy and by use of advanced imaging technique computerized tomography (CT), magnetic resonance imaging (MRI) of nose and paranasal sinuses. Presumptive diagnosis is often made. However, it is a careful histopathological examination which divides the nature of any particular lesion, like neoplastic benign or malignant or non-neoplastic and inflammatory which makes possible to implement correct and timely intervention, which is a major dividing factor for better prognosis.</p><p class="abstract"><strong>Methods:</strong> A total of 100 cases of nasal polyps were studied by the department of ENT at Hassan institute of medical sciences, Hassan during a period of 1 year from January 2019 to January 2020. They were treated surgically by endoscopic excision, lateral rhinotomy or by radical surgery. All the excised masses were sent for histopathological examination to determine their final diagnosis.</p><p class="abstract"><strong>Results:</strong> The middle age group of 21 to 30 years was the most common age group affected with more male predominance. Nearly 85% of the cases were non-neoplastic. The most common presentation was nasal obstruction with ethmoidal sinus being the commonest sinuses seen in the present study.</p><p class="abstract"><strong>Conclusions:</strong> Polypoid lesions in the nasal cavity and paranasal sinuses may range widely from benign to malignant affecting all the ages. Common nasal lesions were seen in age group 21-30 years and maximum lesions were non- neoplastic.</p>

Endoscopic Transnasal Management of Giant Paediatric Sinonasal Ossifying Fibroma.

The ossifying fibroma is a rare fibro-osseous benign lesion of bone in the head and neck region. The mandible is the most common site reported followed by maxilla and other bones of the skull. A paediatric male presented with protrusion of the right eyeball for one-month duration. Further evaluation by diagnostic nasal endoscopy revealed a smooth mass confined to the superior and middle meatus on the right side. Computed tomography of paranasal sinus showed a large heterogenous bony lesion involving the ethmoid and sphenoid sinus and extending laterally into the orbit and superiorly into anterior skull base. Endoscopic biopsy was suggestive of ossifying fibroma. Transnasal endoscopic excision of the lesion was done and the patient is currently on follow-up. This case is reported for the rarity of presentation and the difficulties in management.

Macroscopic anatomy, radiography and computed tomography of normal paranasal sinuses of the adult one-humped dromedary (Camelus dromedarius).

In order to improve the current knowledge of the topography and the anatomy of the paranasal sinuses of the one‐humped dromedary (Camelus dromedarius), we applied both conventional and advanced imaging techniques, namely, radiography and computed tomography (CT). Twelve heads of healthy dromedaries were used; eight heads were dissected to obtain skulls for the fenestration of the sinuses, two heads underwent anatomical sections, and two heads were imaged respectively by radiography and CT. Sinus fenestration allowed observation of sinuses and their communications. In each dissected dromedary's head, the frontal sinus is a large compartment delimited by thick partitions. The sphenoid sinus is divided into small compartments by bony plates. The lacrimal sinus occupies a small cavity in the rostro‐medial lacrimal bone of the orbit. In all dissected heads, there was neither palatal sinus nor ventral conchal sinus. Five images obtained by CT were selected with an excellent correspondence with the anatomical sections. These images allowed a good differentiation between bones and sinus cavities. The visualisation of the sinus cavities and their anatomical limits has better quality using the CT compared to the radiography. Radiographic and CT images are therefore very useful for the interpretation of clinical imaging studies of the dromedary's paranasal sinuses.

Ultrasonography used in the diagnosis of chronic rhinosinusitis: From experimental imaging to clinical practice

There is an increasing incidence of sinusitis cases in outpatient clinics; therefore, new methods for screening and triage are required. Performance of sinus sonography in our outpatient protocol was assessed in order to ascertain the specificity and sensitivity of this imaging method to detect rhinosinusitis. A total of 81 consecutive cases with clinical signs of sinusitis were collected and clinical data compared with sinus sonography results. Moreover, sinus sonography enhanced referral for further computed tomography scans. The results showed that sonography may be a screening method in sinus pathology, with a high sensitivity of 78.3% and a specificity of 93.1%. In the context of the COVID-19 pandemic, the use of ultrasound for paranasal sinus imaging should be reconsidered as in the case of lung sonography. According to data of the present study, sinus ultrasound may be implemented in the emergency departments with no access to standard ENT services and it could be efficient in managing sinusitis in pregnant women and pediatric cases.

Клинический случай длительного пребывания инородного тела в носоглотке

Rhinolithiasis is a rare pathological phenomenon, according to statistics, the incidence of rhinolith is about 1 person per 10,000 otolaryngological outpatients. Often, rhinolith is accompanied by an asymptomatic course and often becomes an accidental finding. Lack of vigilance of the otorhinolaryngologist and neglect of the possibility of using computed tomography of the paranasal sinuses, first of all, at the first stage of the patient’s treatment in an outpatient setting, often leads to an untimely diagnosis of this disease. Meanwhile, late diagnosis of rhinolith can lead to the development of purulent processes, dystrophic and atrophic changes in the nasal mucosa, naso-oral fistulas, dacryocystitis, osteomyelitis and the formation of an epidural abscess. The article presents a case of prolonged (more than 22 years) presence of a foreign body in the nasal cavity in a 26-year-old female patient, which led to the formation of rhinolith. Despite the long-term complaints and clinical manifestations of the disease with constant visits to the otorhinolaryngologist, the patient did not undergo computed tomography of the paranasal sinuses. The prescribed instrumental examinations (CT scan of the paranasal sinuses and endovideoscopy of the nasal cavity) at the Saint Petersburg Research Institute of Ear, Throat, Nose and Speech allowed us to diagnose rhinolitis of the nasal cavity and successfully carry out surgical treatment.

A Rare Case of Giant Dacryocystomucopyocele

Chronic dacryocystitis is frequently caused by Naso Lacrimal Duct (NLD) infection or obstruction. Mucocele is formed when chronic stagnation of tears occurs in the lacrimal sac. When mucocoele gets infected with pyogenic organisms, pyocele is formed. Proximal obstruction in mucopyocele causing encysted dacryocystomucopyocele presenting as an enormous swelling is very uncommon. Very few cases of giant encysted dacryocystomucopyocele are reported in literature. The authors report a 42-year-old male with an acquired, enormous dacryocystomucopyocele, which developed over only one and half years and produced upward displacement of the lower lid and mechanical obstruction for eye closure. Computed tomography of orbit and paranasal sinuses was done to confirm the diagnosis and find out the extent of cyst. Complete surgical excision of the cyst was performed. There was no recurrence of the swelling at last follow-up at 1 year.

Dental findings on face and neck imaging

When it is necessary to evaluate dental structures, the typical method is to obtain intraoral or panoramic X-rays at specialized dental clinics. However, in the daily practice of head and neck radiology, or even general radiology, it is common to encounter clinical situations or examination findings related to dental problems that should not be ignored. Because such problems can often be responsible for the clinical complaints of patients, this review aims to assist radiologists in identifying and describing common dental conditions on computed tomography of paranasal sinuses, face, and neck. It is important for radiologists to have knowledge of dental arch anatomy and its relationships with facial structures, as well as of major dental pathologies, including periapical sclerotic lesions, odontogenic cysts, fistulas, and abscesses, together with knowledge of incidental findings without clinical repercussions, which should be easily identified and stressed by the radiologist when necessary. The imaging methods most commonly used in evaluation of paranasal sinuses and face are computed tomography and magnetic resonance imaging. Those methods allow radiologists to recognize and become familiar with the main dental findings. The description of such findings by a radiologist can lead to a change in treatment strategy.

Editorial Message

Background There is a debate concerning serum iron markers in fungal infections in patients with different diseases, and so far, none has assessed their level in fungal rhinosinusitis. Therefore, this study aimed to detect whether allergic fungal rhinosinusitis is associated with alterations in serum iron markers. Patients and methods Patients of this study were classified into two groups: group A included 35 patients with allergic nasal polyps, and group B included 31 patients with allergic fungal rhinosinusitis. Computerized tomography of paranasal sinuses was performed for all patients. Serum iron and total iron‑binding capacity (TIBC) of all patients were measured, and unsaturated iron‑binding capacity (UIBC) and transferrin saturation (TSAT) were calculated. Results Both the TIBC and UIBC were significantly higher in the allergic fungal rhinosinusitis group than the nasal polyps group. No significant differences were detected in the levels of serum iron and TSAT between the two groups. Conclusion Allergic fungal rhinosinusitis is associated with higher TIBC and UIBC, suggesting a possible role of iron in the pathogenesis of allergic fungal rhinosinusitis. Keywords: allergic fungal sinusitis, iron, nasal polyps, total iron‑binding capacity, unsaturated iron‑binding capacity.

Comparative Study between Nasal Endoscopic Findings and Nose and Paranasal Sinus Computerized Tomography in diagnosis of Nose and Paranasal Sinuses Diseases

Background: Nasal obstruction is common in otorhinolaryngology outpatient visitors. The diagnosis of such compliant is by history, clinical examination and diagnostic procedures. Nasal endoscopy and computerized tomography scan are common diagnostic investigations. Nasal obstruction is either anterior or posterior (nasal septal deviations, hypertrophied turbinate pathological cyst, polyps, mass etc), or postnasal obstruction (hypertrophied turbinate, adenoid hypertrophy, nasopharyngeal cyst or nasopharyngeal tumors).
 Aim of study: Prospective study to compare endoscopic finding and computerized tomography of nose, paranasal sinuses and postnasal space as diagnostic methods for nasal obstruction and other nose, paranasal sinuses and post nasal space diseases.
 Subjects and methods: 80 patients with nasal obstruction between the age of 12-60 years old.All patient were examined by nasal endoscopy (rigid or flexible) under local anaesthesia (10 % xylocaine spray and cotton wicks soaked with ephidren 0.5 % and xylocaine 2 % ) and nose, paranasal sinuses and post nasal space C.T. scan,weather without contrast or with it, bone window or soft tissue according to the lesion. 
 Results: Both nasal endoscopy and C.T. scan were an important tools for diagnosis of nasal diseases and complementary to each other.
 Conclusion: Endoscopic examination of the nose gives a real view of nasal structures, postnasal space, any mass or polyps present.Computerized tomography is an accurate diagnostic method of the Nose, paranasal sinuses and post nasal spaces anatomical variations or pathologies.

EFFICIENCY OF COMPUTED BRAIN TOMOGRAPHY AND MINIMAL PARA-NASAL SINUS SCANNING IN PATIENTS WITH HEADACHE

Background: Headache is the most common human condition and affects a wide range of populations with a number of etiologies. The majority of headaches are accounted for by main headache disorders that involve migraine, cluster and tension-type headaches, whereas secondary headaches are much less common than those with underlying disease (e.g. tumour).
 Aims & objectives: To assess the Utility of computed tomography of brain and limited para-nasal sinuses scanning in patients with headache.
 Methodology: This prospective research included 400 cases of primary headache symptoms undergoing computed brain tomography and minimal para-nasal sinus CT scans. For the diagnostic yield from imaging, findings were tabulated and analysed.
 Results: Isolated headache, accompanied by headache with vomiting, was the most common symptom of referral to CT brain. In 44 subjects, 26 due to intracranial pathology and 18 due to para-nasal sinus disease, a severe abnormality was found. Of the 44 positive cases, 12 were lesions occupying room, 4 vaccine infarctions, 2 subarachnoid haemorrhages, 8 cortical vein thrombosis, and 18 had sinusitis.
 Conclusion: Computed tomography is a useful screening tool in the assessment of headache patients.
 Keywords: Headache, Computed Tomography, Migraine, Para Nasal Sinus.

A CT-Scan review of anatomical variants of sinonasal region and its correlation with symptoms of sinusitis (nasal obstruction, facial pain and rhinorrhea)

Objective:To determine the incidence of anatomical variants of sinonasal region and its correlation with symptoms of sinusitis.Methods:The study was conducted from January-June 2020 at Radiology Department of PNS Shifa Hospital, Karachi. The study involved 50 symptomatic subjects of sinusitis with age ranges from 18-60 years which were prepared for computed tomography of paranasal sinuses. The scans were reviewed for nasal-septum, turbinates, uncinate process, ethmoid air-cells along with other anatomical variants and were correlated with symptoms of sinusitis.Results:Out of 50 subjects, 34 were males and 16 were females with mean age of 42.68±18.22 years. Most common anatomical variants observed were agger nasi cells (64%), deviated nasal septum (56%), and concha-bullosa (46%). Statistically significant correlation existed between bilateral agger nasi cells and nasal obstruction (p=0.017, ρ= -0.336).Conclusion:The anatomy of sinonasal region is highly complex. However, anatomical variants can disturb the sinus mucociliary drainage pathway resulting in patient suffering. Therefore, considering the variable anatomy of sinonasal region, CT-PNS is recommended for every subject in order to avoid surgical hazards.

Effectiveness of Volumetric Reduction of Middle Concha Bullosa by Crushing Technique in Chronic Nasal Obstruction.

To study the effectiveness of volumetric reduction of middle concha bullosa by crushing technique in chronic nasal obstruction cases on selection basis of 3Dimensional computed tomography measurements. Patients with complains of nasal obstruction underwent an Observational study. They were subjected to nasal endoscopy and computed tomography of paranasal sinuses with 3D size estimation of middle turbinate to confirm concha bullosa. 37 patients with unilateral/bilateral lesions were divided into 4 groups on the basis of ranged sizes. These were subjected to volume reduction by crushing technique with marsulizer under local/general anesthesia with necessary post-operative medications and the final outcomes were judged on basis for nasal endoscopy and computed tomography of paranasal sinus at 1year. Out of 37 patients with total 42 concha bullosa, 5 had bilateral lesion. After crushing techniques, following results were obtained. In group A with pre-operative volume of concha between 0.60 and 0.80ccm, 11 succeeded to achieve post-operative value of < 0.60ccm. In group B, C, D with preoperative concha volume > 0.80ccm all succeeded in achieving the post-operative value of < 0.60ccm. 50% reduction in volume of concha occurred in 88% cases of group A and 100% in cases of other groups post-operatively at 1year. Encouraging results with negligible consequences are ensued upon in case of chronic nasal obstruction due to concha bullosa by doing its volumetric reduction by crushing technique with marsulizer instrument.

Morphological, anatomical, radiological and clinical features of Mladina type 6 nasal septum deformations in humans.

The objective of this study was to prove the higher frequency of the type 6 deformations overall compared to the results obtained by conventional diagnostic methods, such as computed tomography images and clinical examination. The study was performed at the Institute of Anatomy, where a total of 114 randomly selected skulls were examined. The skulls were then scanned in a fixed position using the cone-beam technique (CBCT). The literature epidemiological data of the clinical incidence of type 6 in studies that also used Mladina classification were obtained. There was a statistically significant difference (p < 0.0001) in the frequency of type 6 deformation as diagnosed by visual inspection (22.8%) and computed tomography (7.9%). The frequency obtained by CT imaging amounted 7.9% and was almost the same as the results obtained by a clinical examination which varied between 9 and 11%. The frequency of type 6 nasal septal deformation is higher by visual inspection of the skulls than by computed tomography imaging at a level of significance of 0.05. The incidence of type 6 findings on coronal CT images of paranasal sinuses is approximately the same as that found with anterior rhinoscopy. Type 6, visible or concealed; probably have one-fourth to one-fifth people in population, so the number of clinically overlooked and/or unrecognized types 6 is much greater than we thought it to be.

The impact of ivacaftor on sinonasal pathology in S1251N-mediated cystic fibrosis patients.

ImportanceSinonasal symptoms in patients suffering from cystic fibrosis can negatively influence the quality of life and sinuses can be a niche for pathogens causing infection and inflammation leading to a decrease of lung function. Ivacaftor, a potentiator of the Cystic Fibrosis Transmembrane Conductance Regulator protein, has shown improvement in pulmonary function in cystic fibrosis patients with different forms of class III gating mutations. However, the effects of ivacaftor on sinonasal pathology have hardly been studied.ObjectiveTo determine the impact of ivacaftor therapy on sinonasal pathology in patients with cystic fibrosis with an S1251N mutation.DesignProspective observational mono-center cohort study, between June 2015 and December 2016.SettingA tertiary referral center in Utrecht, The Netherlands.ParticipantsEight patients with cystic fibrosis with an S1251N mutation, treated with the potentiator ivacaftor were investigated.ExposuresIvacaftor (Kalydeco, VX-770) therapy. Computed tomography imaging of paranasal sinuses. Nasal nitric oxide concentration measurements and nasal endoscopy.Main outcomes and measuresPrimary outcome is opacification of paranasal sinuses examined with computed tomography scan analysis and scaled by the modified Lund-Mackay score before and one year after treatment. Secondary outcomes are nasal nitric oxide concentration levels, sinonasal symptoms and nasal endoscopic findings before and approximately two months and in some cases one year after treatment.ResultsComputed tomography scan analysis showed a significant decrease in opacification of the majority of paranasal sinuses comparing the opacification score per paranasal sinus before and after one year of treatment with ivacaftor. Median nasal nitric oxide levels significantly improved from 220.00 (IQR:136.00–341.18) to 462.84 (IQR:233.17–636.25) (p = 0.017) parts per billion. Likewise, the majority of sinonasal symptoms and nasal endoscopic pathology decreased or resolved at two months after the use of ivacaftor.Conclusion and relevanceIvacaftor appears to improve sinonasal outcome parameters and thereby sinonasal health in patients with cystic fibrosis with an S1251N mutation.

Supra Maxillary Cell (SMC): An Anatomical variant of Ethmoid Sinus.

65yearold female presented with complaints of Right sided nasalobstruction of 1year duration, intermittent nasal discharge for thepast 6months, without much significant improvement in medical management. Computerized tomography of paranasal sinuses revealed presence of supra maxillary cell (SMC) which was infected, along with sphenoid sinus (Heterodense lesion-suggestive of probable Fungal sinusitis). Patient underwent Functional Endoscopic Sinus Surgery with Septoplasty under local anesthesia. Among the paranasal sinuses, the ethmoid sinus has the largest number of anatomical variations. Important structures near the ethmoid sinus are usually in danger during the endoscopic sinussurgery due to its extreme anatomical variations. Posterior ethmoid cells can alsoexpand towards and into the Maxillary sinus, which drains into the superior nasal meatus, referred to as the Ethmo maxillary sinus. This clinical report highlights about similar anatomical variation in the paranasal sinuses. We report a case of similar type of cell, only difference is it drains into middle meatus, situated mostly over the maxillary sinus alone along its entire width and the senior author has coined a term for it as supra maxillary cell (SMC).

Computed Tomography Image Analysis and Clinical Correlations of Retromaxillary Cells

This study aimed to investigate and analyze the anatomic characteristics of the retromaxillary cell (RMC) by using computed tomography (CT) images of paranasal sinuses and to improve its identification with ethmomaxillary sinus (EMS). The paranasal sinus CT scans of 441 outpatients or inpatients in our hospital from January 2018 to October 2018 were analyzed. The incidence of RMC, EMS, Haller cell, imaging anatomical characteristics, and morphological manifestations were observed via sinus CTs. The relationship of RMC and ipsilateral maxillary sinusitis was analyzed. The incidence of RMC is 83.90% (740/882). The incidence of males and females was 83.81% (414/494) and 84.02% (326/388), respectively. The incidence of bilateral (72.79%, 321/441) was much higher than that of unilateral (22.22%, 98/441). The lateral extension of the RMC ranged from 1.18 to 13.31 mm, with an average of 6.10 ± 2.03 mm. The incidence of ipsilateral maxillary sinus opacification on the RMC sides and non-RMC sides has no significance difference (χ2 = .054, P = .459). The incidence of Haller cell and EMS decreased significantly in the presence of RMC (P < .01). The RMC is an anatomical variation originating from posterior ethmoid cells, which is commonly encountered in the clinic. The pneumatization of RMC is highly variable, and a bilateral is common. During endoscopic sinus surgery, it is necessary to carefully identify such an air cell to ensure the complete opening of the paranasal sinus during surgery.

Paranasal sinuses computed tomography findings in anosmia of COVID-19.

ObjectiveOlfactory dysfunction in coronavirus disease-2019 (COVID-19) is poorly understood. Thus, mechanistic data are needed to elucidate the pathophysiological drivers of anosmia of COVID-19.MethodsWe performed the current study in patients who presented with anosmia and COVID-19 as documented by the polymerase chain reaction (PCR) assay between April 1st and May 15st, 2020. We assessed for the conductive causes of anosmia with computed tomography (CT) of paranasal sinuses.Results49 patients who presented with anosmia and positive PCR assay for COVID-19 were included. The average age was 45 ± 12.2 years. Complete anosmia was present in 85.7% of patients and 91.8% of patients reported sudden onset of olfactory dysfunction. Taste disturbance was common (75.5%). There were no significant pathological changes in the paranasal sinuses on CT scans. Olfactory cleft and ethmoid sinuses appeared normal while in other sinuses, partial opacification was detected only in some cases.ConclusionWe did not find significant mucosal changes or olfactory cleft abnormality on CT imaging in patients with anosmia of COVID-19. Conductive causes of anosmia (i.e., mucosal disease) do not seem play a significant role in anosmia of COVID-19.

Role of computed tomography in the assessment of anatomical variations of maxillary sinus

Background: Maxillary sinus shows normal anatomical variations and it is important to know about them. Evaluating maxillary sinus and identifying its variations on computed tomography not only detects the different variations but also helps in planning and guiding various sinus surgery and preventing possible complications.Purpose: Aim of this study was to detect anatomical variations of maxillary sinuses in patients using Multi-detector Computed Tomography.Materials and Methods: Paranasal sinuses of 56 patients who were subjected to Computerised Tomography of Paranasal Sinus with CT (Seimens 16 slice Somatomscope) machine were studied.Results: A total Para Nasal Sinuses of total 56 patients were studied. Out of which only 33 patients had maxillary sinus variations. Among accessory ostia of maxillary sinus was the commonest anatomical variation and was seen in 14(25%) of cases. Hyper pneumatization of maxillary sinus was detected in 12 cases (21.4%) and maxillary antral septa were found in 7 cases (12.5%).Conclusion: Accurately assess the maxillary sinus on Computed Tomography and to determine the various anatomical variations of the same so as to differentiate pathological lesions from an anatomical variation and avoiding unnecessary surgical explorations and complications.

Role of computed tomography in the assessment of anatomical variations of ethmoid sinus

Introduction: Anatomical variations of ethmoidal sinuses are complex and surgically very important. Preoperative detection of these variants is important to prevent surgical complications. Multidetector Computed Tomography (MDCT) is the modality of choice for evaluation of these variants of ethmoidal sinuses.Aim: To study the normal anatomical variations of ethmoidal sinuses by 16 slice MDCT.Materials and Methods: This was a retrospective analysis of paranasal sinuses in 70 cases by MDCT in adults. Axial and coronal images of Paranasal Sinuses (PNS) were taken by 16 slice MDCT. Statistical analysis was done using SPSS version 20.0.Results: Present study shows haller cells as the most common anatomical variant with 21 (30%) cases, followed by onodi cells in 10 (14.29%) cases, agger nasi cell in 9 (12.86%) cases and supra orbital cell in 8 (11.43%) patients.Conclusion: Ethmoidal sinuses form a major component of paranasal sinuses that have high prevalence of anatomical variations. These ethmoid sinus anatomical variants are frequent causes for complicated sinus inflammatory pathologies and failed sinus surgeries. The surgeons must be aware of the anatomical variations to avoid untoward surgical complications and for better surgical outcome.

Study of Correlation between Endoscopic Assessment and Radiological Evaluation in Chronic Nasal Obstruction

Introduction: Chronic nasal obstruction is one of the most common chronic diseases and affects nearly 50 million individuals every year the world over. The diagnosis of diseases associated with chronic nasal obstruction relies heavily on the clinical judgment. However the degree of accuracy in diagnosis of many reported cases with chronic nasal obstruction has exponentially increased owing to modern diagnostic methods like computed tomography of paranasal sinuses and diagnostic nasal endoscopy. The aim of the study is to implement the consistency among the findings of CT, X ray soft tissue and endoscopic findings of the PNS. This will help in a better understanding of the disease, its diagnosis and management. Methodology: This was a prospective observational study. The study was conducted in all the patients coming to the department of ENT in a tertiary health care centre. Patients of any age group with a history of nasal obstruction &gt; 3 months not resolved in spite of medications were included in the study. An informed consent was obtained from the participants. Diagnostic nasal endoscopy and CT Scan PNS and or x-ray nasopharynx was done in 35 patients, suffering from chronic nasal obstruction. Results: A highly significant positive correlation was found between nasal endoscopic and radiological findings. Conclusion: A detail assessment of radiological and endoscopic findings is necessary for tailoring surgical plan .No single procedure can be sufficient in accurately diagnosing chronic nasal obstruction and both the preoperative CT and endoscopic examination are complementary to each other.